What is it?
De Quervain’s disease, named after the man who first described the condition: Fritz de Quervain in 1895, is due to tenosynovitis (inflammation) of the tendons on the outside of the wrist near the base of the thumb. These tendons help move the thumb. They run in a tendon sheath (tunnel). Inflammation in the tendons causes them to swell and then to rub on the sides of the tendon sheath. This causes the symptoms of De Quervain’s disease: pain on the side of the wrist.
Why has it occurred?
In most patients De Quervain’s disease occurs for no apparent reason. Occasionally it can occur following a minor injury to the thumb. It is more common in females than males.
How is it diagnosed?
De Quervain’s disease can usually be diagnosed when I see you. Occasionally an x-ray and or an ultrasound scan are required to exclude other conditions, which cause similar symptoms.
What is the treatment for it?
If the symptoms are mild and have not been present for very long, a short period of rest with a splint may help. However, most patients experience a reoccurrence of their symptoms once the splint has been removed. Therefore, an injection is usually recommended.
In the most severe cases, surgery is recommended.
The tendon sheath (tunnel) in which the tendons run can be injected in the outpatient department when you are seen. The tendon sheath (tunnel) is injected with a mixture of local anaesthetic (pain killer) and steroid (anti-inflammatory drug). The local anaesthetic helps to reduce the pain in the short-term and the steroid helps to reduce the swelling (inflammation) and pain in the long-term.
Does the injection hurt?
Normally there is no more pain than a normal injection for a blood test or vaccination.
What happens after the injection?
Sometimes you are advised to rest the wrist and thumb as this may help the pain and swelling to settle down. A splint may be used.
Are there any side effects from the injection?
Patients may experience a warm reddening of the skin for a short while after the injection.
An increase in pain can occur after the injection. This varies considerably but may last up to 72 hours. The local anaesthetic is given with the injection to help reduce this side effect. Very occasionally some of the steroid leaks into the skin. This can cause the skin over the injection site to become lightened in colour. This effect is often temporary, but occasionally it can be permanent. The amount of steroid injected into the joint is very small and the body quickly removes it. It does not have any of the general effects found with taking long term steroids.
How long do the benefits of the injection last?
As everyone is an individual, some may have more benefit than others. Usually, the beneficial effects of the injection will be within weeks. In some people, these benefits may be permanent.
Can the injection be repeated?
Yes. Occasionally the injection may be repeated if your symptoms are not completely eased.
How successful are the injections?
Treatment with injections helps in approximately 50 to 70 % of patients but it depends on how severe the tenosynovitis is.
Surgery is required for the most severe cases of tenosynovitis and when the symptoms do not respond to injections. Surgery involves dividing part of the roof of the tendon sheath (tunnel) in which the tendons are swollen. This allows the tendons to move more freely in the tendon sheath (tunnel), relieves the inflammation and resolves the pain.
What type of anaesthetic will I have?
The surgery is normally performed under a local anaesthetic. Occasionally a general anaesthetic or regional anaesthetic (block) is required. This can be discussed with you.
How long will I be in hospital?
The majority of patients can be admitted and discharged home the same day (Day Case Surgery). A small number of patients require an overnight admission.
What is the treatment after surgery?
You will often be encouraged to start moving the wrist and thumb straight away. After the surgery you will have a bandage on and may have stitches to be removed but this will not prevent you from moving your wrist and thumb. Occasionally, a plaster of Paris splint is used to immobilise the wrist and thumb for 10 to 14 days. It is advisable to avoid heavy manual work for 4 to 6 weeks after the surgery.
What are the risks of surgery?
The risk of surgery is very small but includes bleeding, infection and stiffness. In addition, there is a nerve close to where the operation occurs which can be injured as a result of surgery. This can be a significant problem. I will be happy to discuss any questions you may have about these risks with you.
How successful is the surgery?
The success rate of surgery is very good. Recurrence after surgery is very rare.